The College of Psychiatrists of Ireland has said that Government failings on mental health are putting patients' lives at risk and the body has called for an urgent overhaul of the entire system.
It has described as "unacceptable" the current waiting lists for children and adults in need of urgent care, as "inadequate" the provision of mental health services for prisoners and said that there is a significant recruitment and retention crisis among doctors.
Speaking on RTÉ's Morning Ireland, Dr William Flannery, Consultant Psychiatrist and President of the College of Psychiatrists of Ireland, said a "radical" approach is needed to fix issues across the system.
"We have a crisis in child services, but not only child services, its across the entire system, so its in the prisons, its the neglected state of our mental health beds, and there's waiting lists across the system," Dr Flannery said.
"This means that patients will end up in the emergency department which really is just not right," he said.
Dr Flannery said there had been several crises in Child and Adolescent Mental Health Services (CAMHS), and that several thousand young people who had been referred by a GP for urgent care are being "effectively turned away".
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Preliminary figures provided to RTÉ News by the HSE show that from the beginning of 2022 to the end of July, 4,846 of 12,673 GP referrals of young people to CAMHS were not accepted.
A HSE spokesperson described this as a "specialist clinical service", adding that it was "not for everyone" and that "only a small percentage of the population would require access to this service."
The spokesperson also said that where a referral is "deemed unsuitable for CAMHS", the person referred and their GP are "are signposted ... to the most appropriate service".
Both the HSE and the Department of Health highlighted that urgent referrals are prioritised, and over 90% of them are seen within three days.
A Department spokesperson also said that in 2021 the number of new referrals to CAMHS was up by 25% from 2020, and the new referrals seen in the same period increased by 17%.
Consultant Liason Psychiatrist at the Mater Misericordiae University Hospital in Dublin, Professor Anne Doherty said that mental health services across the board are becoming increasingly stretched.
"The numbers in our own hospital have gone up by 170% since the beginning of Covid, the numbers of people presenting primarily in mental health crisis have risen dramatically, and I think a lot of our colleagues across the country are seeing very similar numbers." Prof Doherty told RTÉ News.
Prof Doherty works with many patients who are present in the hospital's Emergency Department, including children aged over 16.
Prof Doherty said: "What we are seeing are people who would maybe have been better treated somewhere else are ending up a crisis and having to come to an emergency department, and its heartbreaking to see people with mental health problems, some adults, some children, their parents, their family, their carers, in a situation where things have dragged on to the point that it is a crisis."
The Irish College of Psychiatrists of Ireland has called for the urgent reforms to the entire mental health system, including the reinstatement of a Director for Mental Health Services within the HSE, alongside the appointment of a Chief Psychiatrist in the Department of Health and a National Clinical Lead for CAMHS.
The Programme for Government committed to "examine" the first two, and following the publication in January of a review of South Kerry CAMHS, which found that 240 children received risky care during a four-year period, and 46 service users had experienced serious harm, Minister of State in Department of Health with responsibility for Mental Health Mary Butler told the Dáil she believed the reinstatement of a Director for Mental Heath within the HSE was "essential."
The Department of Health confirmed that "Minister Butler has consistently called for the reinstatement of a national director for mental health and she continues to engage with the HSE on how to best progress."
The Department spokesperson also said that "Mental Health remains a priority for the Government and Minister Butler, including progressing Programme for Government commitments."
"The solutions and the plans are all there, what we want is a radical will to act on it, and implement it," Dr Flannery said.
The Irish College of Psychiatrists of Ireland also wants to see the budget for mental health services doubled, from 5.6% of the current health budget to at least 12%.
The Department of Health said that 2022 HSE National Service Plan allocation for Mental Health of €1.159 billion, which included €24m for new developments, €10m for mental health initiatives in response to Covid and €13m for existing levels of service "reflects a balance of prioritised new developments across mental health and suicide prevention."
On recruiting and retaining staff, Dr Flannery said that according to the HSE's Medical Workforce Planning Ireland report, "around 20% of consultant psychiatrist posts are not filled or are inappropriately filled."
Dr Flannery said that said that Irish College of Psychiatrists of Ireland is allowed take 80 people per year, and based on last year's figures they could have taken a further 20 to 30 people but this needs to be supported by funding. He said that training costs €1.9m and only €1.3m is provided for it.
"We would have serious concerns of any service that doesn't have any fully trained and competent consultant psychiatrist in position. What is so frustrating for families and individuals is to navigate through the system, that is why we are calling for a radical action. We cannot continue with this underfunded, under resourced and well under appreciated service," Dr Flannery said.
According to the Department of Health "progress is being made under implementation of Sharing the Vision (metal health policy) on a joint review of the two specialist training programmes by the College of Psychiatrists of Ireland and the Irish College of General Practitioners to develop an exemplary model of mental health medical training and integrated care."
On the issue of mental health services for those in the prison system, the Irish Penal Reform Trust welcomed that concerns in this area had been raised by the Irish College of Psychiatrists of Ireland.
"We know people in prison are much more likely to have some sort of mental health illness, and are more than four times more likely to have a severe mental health illness and what we are seeing is people are being committed to prison without appropriate treatment being put in place," Saoirse Brady, Executive Director of the Irish Penal Reform Trust told RTÉ News.
"We know the central mental hospital is full but people aren't being diverted anywhere else to an approriate mental health facility where they can get that mental heath assistance that they need, instead its being left to the prisons to try and fill that gap," Ms Brady said.
The Department of Health has confirmed that the final report of a High-Level Task Force on the mental health and addiction challenges of those who come into contact with the criminal justice sector "will be brought be Government for approval in the near future."
Ms Brady said this is due to having an action plan, with a timeline and she has also called for it to have "adequate resources."
Ms Brady also called for an independent prison health needs assessment to be published.
